Problem Of Antimicrobial Resistance Research Articles

Levofloxacin-Fatty Acid Systems: Dual Enhancement Through Deep Eutectic Formation and Solubilization for Pharmaceutical Potential and Antibacterial Activity.

Fatty acids, including medium-chain saturated and polyunsaturated fatty acids, are known for their broad health benefits, including antimicrobial activity. Through their green properties, deep eutectic systems have been heralded as having the potential to be at the forefront of pharmaceutical applications. In this work, capric acid and geranic acid, two examples of medium-chain saturated and polyunsaturated fatty acids, were employed to enhance the pharmaceutical properties and the antibacterial activity of levofloxacin. To this end, levofloxacin formulations with either capric or geranic acid were prepared and characterized using appropriate techniques. Levofloxacin was utilized to create innovative deep eutectic systems in conjunction with capric acid at three different molar ratios: 1:9, 2:8 and 3:7. This was confirmed through a rigorous analysis involving nuclear magnetic resonance, infrared spectroscopy and differential scanning calorimetry. Furthermore, it is noteworthy that geranic acid demonstrated an impressive threefold improvement in levofloxacin's solubility compared to its solubility in aqueous solutions. The antibacterial activity of the novel combinations of levofloxacin with either fatty acid was evaluated using a checkerboard titration assay. Gratifyingly, both formulations exhibited synergistic effects against a panel of levofloxacin-sensitive and resistant Gram-negative bacteria. In conclusion, the observed superior antibacterial activity of levofloxacin illuminates the potential use of fatty acid-based formulations and deep eutectic systems as green and innovative strategies to combat the global antimicrobial resistance problem.

Streptomyces: a natural source of anti-Candida agents.

Introduction. There is an urgent need to source new compounds that can combat the current threat of serious infection caused by Candida spp. and contend with the problem of antimicrobial resistance. Gap. A synthesis of the evidence available from the current literature is needed to identify promising antifungal chemotherapeutics. Aim. To highlight anti-Candida compounds derived from Streptomyces spp. (a well-known source of antimicrobial compounds) that could translate to potential candidates for future clinical practice. Methodology. A comprehensive review was conducted across three scientific literature databases spanning a 13-year period. Results. We identified 151 compounds with anti-Candida activity. Amongst these, 40 were reported with very strong inhibitory activity, having minimum inhibitory concentrations (MICs) against Candida spp. of <3.5 µg ml−1, 66 compounds were considered strong inhibitors and 45 compounds exhibited moderate inhibitory potential. From an analysis of the MICs, we deduced that the actinomycin-like compounds RSP01 and RSP02 were probably the most promising anti-Candida compounds. Other antifungals of note included filipin-like compounds, which demonstrated superior inhibition to amphotericin B and activity against Candida glabrata and Candida krusei, and bafilomycin derivatives, which had substantial inhibition against Candida parapsilosis. Conclusion. It is essential to recognize the limitations inherent in the quest for new antifungals, which encompass toxicity, in vivo effectiveness and constraints associated with limited data access. However, further investigation through in-depth study and emerging technologies is of paramount importance, given that there are still many more compounds to discover. This review highlights the importance of antifungal compounds derived from Streptomyces , which demonstrate robust inhibition, and, in many cases, low toxicity, making them promising candidates for the development of novel antifungal agents.

Antimicrobial resistance expansion in pathogens: a review of current mitigation strategies and advances towards innovative therapy

Abstract The escalating problem of antimicrobial resistance (AMR) proliferation in clinically important pathogens has become one of the biggest threats to human health and the global economy. Previous studies have estimated AMR-associated deaths and disability-adjusted life-years (DALYs) in many countries with a view to presenting a clearer picture of the global burden of AMR-related diseases. Recently, several novel strategies have been advanced to combat resistance spread. These include efflux activity inhibition, closing of mutant selection window (MSW), biofilm disruption, lytic bacteriophage particles, nanoantibiotics, engineered antimicrobial peptides, and the CRISPR-Cas9 gene-editing technique. The single or integrated deployment of these strategies has shown potentialities towards mitigating resistance and contributing to valuable therapeutic outcomes. Correspondingly, the new paradigm of personalized medicine demands innovative interventions such as improved and accurate point-of-care diagnosis and treatment to curtail AMR. The CRISPR-Cas system is a novel and highly promising nucleic acid detection and manipulating technology with the potential for application in the control of AMR. This review thus considers the specifics of some of the AMR-mitigating strategies, while noting their drawbacks, and discusses the advances in the CRISPR-based technology as an important point-of-care tool for tracking and curbing AMR in our fight against a looming ‘post-antibiotic’ era.

Attenuation of biofilm and quorum sensing regulated virulence factors of an opportunistic pathogen Pseudomonas aeruginosa by phytofabricated silver nanoparticles

Green-synthesized nanoparticles provide an effective strategy for inhibiting microbial pathogenesis by affecting biofilm formation, quorum sensing (QS), and other surface properties of microorganisms. QS is a density-dependent communication signaling cascade that regulates biofilm formation and other pathogenic factors of Pseudomonas aeruginosa. In this context, the effect of phytofabricated silver nanoparticles (CC-AgNPs) synthesized using Cuphea carthagenensis extract on biofilm, QS, and QS-dependent virulence factors of P. aeruginosa were evaluated in this study. CC-AgNPs demonstrated significant attenuation of biofilm, QS, and QS-dependent virulence factors at sub-MICs. A significant inhibition of 88.39 ± 4.32 %, 79.64 ± 3.31 %, 73.07 ± 3.0 %, and 61.67 ± 1.5 % of biofilm formation, quorum sensing, pyocyanin, and LasB elastase, respectively was reported in the study at 20 μg/mL. The study also demonstrated a significant reduction of LasA Staphylolytic activity and 91.37 ± 1.05 % exoprotease production in comparison to untreated control. The lower concentrations of CC-AgNPs also demonstrated significant attenuation of biofilm and other virulence factors suggesting the strong potency of NPs against P. aeruginosa. XTT analysis reported the effect of CC-AgNPs on sessile cells of P. aeruginosa without impacting growth of planktonic cells at sub-MICs. Cell-proliferation study in human cell lines (HEK 293 and Caco-2 cells) demonstrated the safe nature of CC-AgNPs at tested concentrations. This study is novel in a way that environmentally friendly CC-AgNPs were used to inhibit QS at sub-MICs without killing the tested strains, therefore, could be developed as an anti-virulent drug to overcome biofilm and antimicrobial resistance problems.

The challenges of implementing antibiotic stewardship in diverse poultry value chains in Kenya

This paper investigates the challenges of implementing antibiotic stewardship – reducing and optimizing the use of antibiotics – in agricultural settings of Low- and Middle-Income Countries (LMICs) as a strategic part of addressing the global problem of antimicrobial resistance (AMR). It does so through analysis of the rapidly transforming yet diverse Kenyan poultry sector, characterized by growing commercial operations alongside traditional smallholder farming. Our research involves interviews with farmers, processors, policymakers, and agro-veterinary stores in these settings. We blend Chandler’s (2019, p. 8) notion of “antibiotics as infrastructure” with value chain frameworks to understand how the structural role of antibiotics in agriculture plays out through contrasting value chains, with different implications for stewardship. Weak regulation and intense market-based pressures are shown to drive widespread antibiotic use in poultry value chains involving small- and medium-sized farms supplying open markets. Antibiotic stewardship through adherence to agricultural and food safety standards is more evident, though unevenly observed, in value chains involving large commercial farms and processors supplying corporate buyers. Our findings reveal the complex structural roles of antibiotics in maintaining producer livelihoods in an intensely competitive and heterogeneous Kenyan poultry sector. This highlights challenges with applying global AMR policy to transforming food systems in LMICs without appropriate translation. We argue that attempts to reduce and optimize the use of antibiotics in agriculture must be informed by nuanced understandings of the roles of antibiotics in food systems in specific places including where very different scales and models of farming and value chain co-exist.

Making sense of ‘implementation gaps’ as a governance problem of antimicrobial resistance

Abstract Background Antimicrobial resistance (AMR) is a pressing global health issue. National Action Plans on AMR (NAP-AMR) are key to mitigate AMR, however, effective translation of action plans has been a governance challenge worldwide. This study explores the implementation gap in Austria by examining experiences of experts involved in domestic AMR policy. Methods This study was guided by grounded theory. Data were collected through qualitative interviews, a focus group, and participation in AMR symposia. Overall, 13 participants were identified through theoretical sampling. Data collection and analysis took place until theoretical saturation was achieved. Results Experts identified the following central themes affecting AMR mitigation: absence of a binding legal framework, paucity of AMR data, low risk perception among decision makers, lack of funding, and insufficient incentive systems for people dedicated to AMR stewardship. Conclusions The interpretation of these findings suggests policy fragmentation, scattered responsibilities, agenda conformity and a lack of recognition as core features which impede a sustainable and effective AMR-related governance. The results should alert policymakers to sustainable public health interventions in the following areas: a) Institutional responsibilities need to be restructured to prioritize AMR stewardship as a guiding principle. b) Investments are necessary for nationwide implementation of AMR stewardship and surveillance systems. c) Financial and symbolic incentives for people dedicated to AMR mitigation are imperative. Key messages • There is a tension between local efforts to make adjustments to mitigate AMR and the current approach of ‘superimposing’ reforms on existing structures. • Effective measures to address AMR require that priority be given to mitigating AMR.

Control of Biofilm and Virulence in Pseudomonas aeruginosa by Green-Synthesized Titanium–Cerium Nanocomposites

Antimicrobial resistance (AMR) has become a critical global health challenge. Infections, particularly those caused by multidrug-resistant (MDR) pathogens, rank among the top causes of human mortality worldwide. Pseudomonas aeruginosa occupies a prominent position among pathogens responsible for opportunistic infections in humans. P. aeruginosa stands as a primary cause of chronic respiratory infections, significantly contributing to the burden of these chronic diseases. In the medical domain, nanotechnologies offer significant potential, spanning various applications, including advanced imaging, diagnostic devices, drug delivery systems, implants, tissue-engineered structures, and pharmaceutical treatments. Given the challenges associated with AMR and the limited discovery of new drugs to combat MDR microbes, there is a critical need for alternative strategies to address the problem of AMR. In this study, we synthesized titanium–cerium nanocomposites (Ti–Ce–NCs) using an eco-friendly green synthesis approach. X-ray diffraction (XRD) analysis confirmed the crystalline nature of the Ti–Ce–NCs and determined the particle size to be 17.07 nm. Electron microscopy revealed the size range of the particles to be 13 to 54 nm, where the majority of the particles were in the 20 to 25 nm range. Upon examining the composition, the Ti–Ce–NCs were determined to be composed of cerium, oxygen, and titanium, whose relative abundance were 36.86, 36.6, and 24.77% by weight, respectively. These nanocomposites were then evaluated for their effectiveness against various virulent traits and biofilms in P. aeruginosa. Out of six tested virulence factors, more than 50% inhibition of five virulence factors of P. aeruginosa was found. Roughly 60% inhibition of biofilm was also found in the presence of 400 µg/mL Ti–Ce–NCs. The nanocomposites also altered the biofilm architecture of the test bacterium. The success of this research opens doors for the potential use of such nanomaterials in the discovery of new antibacterial agents to combat drug-resistant bacteria.

부산의 실내환경에서 분리된 항생제 내성유전자

The problem of antimicrobial resistance genes and antimicrobial resistant bacteria is a very serious problem throughout the world. Korea has recognized the importance of antimicrobial resistant pathogen and has been making efforts to solve the problem of antimicrobial resistance for a long time. However, the problem of antimicrobial resistance has not yet been solved. A total of 58 filter samples were collected from 14 hospitals, 32 nurseries, and 6 out of doors during January and May 2017. For detection of class A, C, and D β-lactamase genes, aminoglycosides, fluoroquinolones, and tetracyclines, polymerase chain reactions (PCR) were performed. Among the 58 samples, 17 isolates (78.8%) showed positive results in the PCR test, but none of the samples showed positive for aminoglycoside and fluoroquinolone gene detection primers. Therefore, this study makes us realize that we need to protect the people and animal health by monitoring antimicrobial resistant bacteria and antimicrobial resistant genes in the indoor and outdoor air.

Urgent imperatives and perspectives of Antimicrobial resistance

Antimicrobial resistance (AMR) is a pressing global health issue that threatens the effectiveness of antibiotics in treating infectious diseases. This study examines the current landscape of AMR with a specific focus on the emergence and spread of multidrug-resistant bacteria. The factors contributing to the development and spread of AMR including the overuse and misuse of antibiotics in human and animal health sectors are discussed. The mutations of bacterial genes causing AMR, highlighting their role in promoting the survival and proliferation of drug-resistant bacteria are analyzed. The consequences of AMR are far-reaching and include increased morbidity, mortality and healthcare costs. The assessment highlights the impact of medical wastes such as patient samples, clinical and drug wastes and agro-based wastes such as surface runoff of poultry and cattle medication on AMR. To address the challenge of AMR, the analysis emphasizes the need for novel antimicrobial agents. The importance of public awareness, awareness among decision makers and appropriate attention and schemes is also discussed as a promising approach to combat AMR. In conclusion, this appraisal sheds light on the escalating problem of AMR and the urgent need for effective strategies to wrestle it. The findings underscore the importance of a multidisciplinary approach involving healthcare professionals, researchers, policymakers and the public to mitigate the impact of AMR and to ensure the availability of effective treatments for infectious diseases in the future. By addressing the challenges posed by AMR, we can safeguard public health and promote sustainable use of antibiotics.

Empiric antimicrobial therapy in the intensive care unit based on the risk of multidrug-resistant bacterial infection: a single-centre case‒control study of blood culture results in Japan

BackgroundInfections and sepsis are the leading causes of death in intensive care units (ICUs). Antimicrobial agent selection is challenging because the intervention is directly related to the outcome, and the problem of antimicrobial resistance (AMR) must be considered. Therefore, in this study, we aimed to clarify the epidemiological data and examine whether the detection rate of multidrug-resistant (MDR) bacteria differed depending on the presence or absence of the risk of MDR bacterial infections to establish guidance regarding the choice of antimicrobial therapy for ICU patients.MethodsThis retrospective case‒control study was performed in a single ICU in Japan. Patients admitted to the ICU who underwent blood culture (BC) analysis were considered for inclusion in this study; patients were at risk of MDR bacterial infections, and controls were not. The primary outcome measure was the detection rate of MDR bacteria in BCs collected from patients and controls. The secondary outcome measure was the selection rate of anti-Pseudomonas and anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs for patients and controls.ResultsAmong the 1,730 patients admitted to the ICU during the study period, BCs were obtained from 186 patients, and 173 samples were finally included in the analysis (n = 129 cases; n = 44 controls). No MDR bacteria or Pseudomonas aeruginosa were detected in the controls (14 (11%) vs. 0 (0%)) (P = 0.014) However, there was no difference in empiric antimicrobials, including anti-MRSA (30 (23%) vs. 12 (27%)) (P = 0.592) and anti-Pseudomonas aeruginosa (61 (47%) vs. 16 (36%)) (P = 0.208) drugs, that were administered to the two groups.ConclusionsEven in critically ill patients in the ICU, MDR bacteria are unlikely to be detected in patients without the risk of MDR bacterial infections. Therefore, for such patients, a strategy of starting empiric narrow-spectrum antimicrobial therapy rather than empiric broad-spectrum therapy should be considered. This strategy, in conjunction with daily updates of clinical and epidemiological data at each facility, will promote the appropriate use of antimicrobials and reduce the emergence of MDR bacteria in the ICU.Trial registration: None.

Between superimposition and local initiatives: Making sense of ‘implementation gaps’ as a governance problem of antimicrobial resistance

Mitigating antimicrobial resistance (AMR) is a global imperative. Part of this effort is the translation of the Global Action Plan into National Action Plans on AMR (NAPs-AMR). However, effective implementation of these plans remains a governance challenge worldwide.This study aims to explore the apparent implementation gap as a governance problem in Austria by examining the situated perspectives of key experts and stakeholders involved in AMR-related policy and practice. Data were collected through semi-structured qualitative interviews, a focus group discussion, and participation in various symposia on AMR. Data analysis revealed key themes the experts have identified as decisive factors shaping AMR governance, which they perceive as insufficient. These include: the absence of a binding legal framework, incomplete and lacking AMR data, low risk perception, lack of funding mechanisms, and absence of an incentive system for people working in AMR stewardship.The interpretation of these findings suggests policy fragmentation, scattered responsibilities, agenda conformity and a lack of symbolic and material recognition as central features that impede a comprehensive, sustainable and effective AMR-related governance. These insights highlight a tension between local efforts to precipitate longer-term adaptations to prepare for and mitigate effectively AMR on the one hand, and the current approach of ‘superimposing’ reforms onto existing institutional structures. Effective and sustainable measures to address AMR require a fundamental restructuring process of institutional responsibilities, professional routines, and social practices to prioritize AMR stewardship as a guiding principle.

Upcycling of waste EPS beads to immobilized codoped TiO2 photocatalysts for ciprofloxacin degradation and E. coli disinfection under sunlight

The emerging global problem of antimicrobial resistance needs immediate attention. In this regard, this work demonstrates the use of expanded polystyrene waste in the synthesis of immobilized photocatalytic films for the treatment of antibiotics as well as for bacterial disinfection. A boron–cerium codoped TiO2 catalyst (of specific composition: B0.8Ce0.2TiO2) was immobilized in an expanded polystyrene (EPS) film prepared from waste EPS beads. These films were studied for the degradation of ciprofloxacin (CIP) and disinfection of E. coli under sunlight. The film with a catalyst loading of 20 wt% showed a maximum degradation of 89% in 240 min with a corresponding TOC reduction of 84%. A 7.4 and 6.3 log reduction from the bacterial inactivation studies in the presence and absence of antibiotics, respectively, was obtained. The EPS film was stable after five times of reuse, and no significant chemical changes in the used film were observed from FTIR analysis. The average thickness of the prepared film was found from FESEM analysis to be 1.09 mm. These EPS films were also tested for degradation of other antibiotics, such as norfloxacin, levofloxacin and moxifloxacin. The EPS films were tested in two different reactor volumes at optimum conditions. Also, the effectiveness of B0.8Ce0.2TiO2/EPS film in real water samples indicates its potential in large-scale and real-world applications. Thus, these B0.8Ce0.2TiO2/EPS films can be effectively employed for both degradation of ciprofloxacin and the disinfection of E. coli under solar light to solve the increasing problem of antimicrobial resistance.

Ecology and resistance to UV light and antibiotics of microbial communities on UV cabins in the dermatology service of a Spanish hospital

Microorganisms colonize all possible ecological habitats, including those subjected to harsh stressors such as UV radiation. Hospitals, in particular the UV cabins used in phototherapy units, constitute an environment in which microbes are intermittently subjected to UV irradiation. This selective pressure, in addition to the frequent use of antibiotics by patients, may represent a threat in the context of the increasing problem of antimicrobial resistance. In this work, a collection of microorganisms has been established in order to study the microbiota associated to the inner and outer surfaces of UV cabins and to assess their resistance to UV light and the antibiotics frequently used in the Dermatology Service of a Spanish hospital. Our results show that UV cabins harbor a relatively diverse biocenosis dominated by typically UV-resistant microorganisms commonly found in sun-irradiated environments, such as Kocuria, Micrococcus or Deinococcus spp., but also clinically relevant taxa, such as Staphylococcus or Pseudomonas spp. The UV-radiation assays revealed that, although some isolates displayed some resistance, UV is not a major factor shaping the biocenosis living on the cabins, since a similar pool of resistant microorganisms was identified on the external surface of the cabins. Interestingly, some Staphylococcus spp. displayed resistance to one or more antibiotics, although the hospital reported no cases of antibiotic-resistance infections of the patients using the cabins. Finally, no association between UV and antibiotic resistances was found.

Modulation of quorum sensing and biofilm of Gram-negative bacterial pathogens by Cinnamomum zeylanicum L.

The development of antibiotic resistant microbial pathogens has become a global health threat and a major concern in modern medicine. The problem of antimicrobial resistance (AMR) has majorly arisen due to sub-judicious use of antibiotics in health care and livestock industry. A slow progress has been made in last two decades in discovery of new antibiotics. A new strategy in combatting AMR is to modulate or disarm the microbes for their virulence and pathogenicity. Plants are considered as promising source for new drugs against AMR pathogens. In this study, fraction-based screening of the Cinnamomum zeylanicum extract was performed followed by detailed investigation of antiquorum sensing and antibiofilm activities of the most active fraction that is, C. zeylanicum hexane fraction (CZHF). More than 75% reduction in violacein pigment of C. violaceum 12472 was overserved. CZHF successfully modulated the virulence of Pseudomonas aeruginosa PAO1 by 60.46%-78.35%. A similar effect was recorded against Serratia marcescens MTCC 97. A broad-spectrum inhibition of biofilm development was found in presence of sub-MICs of CZHF. The colonization of bacteria onto the glass coverslips was remarkably reduced apart from the reduction in exopolymeric substances. Alkaloids and terpenoids were found in CZHF. GC/MS analysis revealed the presence of cinnamaldehyde dimethyl acetal, 2-propenal, coumarin, and α-copaene as major phytocompounds. This study provides enough evidence to support potency of C. zeylanicum extract in targeting the virulence of Gram -ve pathogenic bacteria. The plant extract or active compounds can be developed as successful drugs after careful in vivo examination to target microbial infections. RESEARCH HIGHLIGHTS: Hexane fraction of Cinnamomum zeylanicum is active against QS and biofilms. The broad-spectrum antibiofilm activity was further confirmed by microscopic analysis. Dimethyl acetal, 2-propenal, coumarin, α-copaene, and so forth are major phytocompounds.

Drivers of antimicrobial resistance in layer poultry farming: Evidence from high prevalence of multidrug-resistant Escherichia coli and enterococci in Zambia.

Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia. This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR. In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems. This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers.

Titanium Dioxide Nano-Formulation: Characterization, Antimicrobial Activity, and Wound Healing in Animals.

The use of metal oxide nanoparticles as an alternative antimicrobial agent has gained attention due to the increasing problem of antimicrobial resistance. Understanding its properties and potential benefits can contribute to the development of more effective and sustainable treatments in veterinary medicine. The aim of this study was to characterize TiO2-NP formulations and evaluate their antibacterial and wound healing abilities. The diameters and zeta potentials were determined using the Zetasizer in conjunction with dynamic light scattering. The agar-well diffusion method, time-kill kinetic assay and crystal violet assay were used to evaluate their antimicrobial activities. Wound healing assays were conducted both in vitro and in vivo. The study demonstrated that TiO2-NP formulations exhibit significant antimicrobial properties against various bacterial strains such as S. aureus and E. coli. No measurable E. coli growth was observed within a 15-min period following exposure to TiO2-NP formulations. The TiO2-NP formation can improve wound healing by enhancing cell migration and collagen formation in both in vitro and in vivo conditions. In summary, our study suggests that TiO2-NP has the potential for use as an antimicrobial agent for animal wound treatment due to its ability to suppress bacterial growth and biofilm formation, as well as to enhance wound healing.

A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital.

The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.

Knowledge, attitude, and practice (KAP) of antimicrobial prescription and its resistance among health care providers in the COVID-19 era: A cross sectional study.

Antimicrobial resistance (AMR) is considered as a global health and development threat. During COVID-19 pandemic, there has been an increase in antimicrobial resistance. Health care providers (HCPs) play the main role in facing antibiotic resistance because they have the authority to prescribe antibiotics during clinical practice as well as in promoting patients' compliance with therapies and avoid self-medication. So, this study will serve as an important source of information in context with Covid19 pandemic in Egypt. The data was collected using a validated standardized self-administered online questionnaire compromised of four sections: socio-demographic data of the HCPs, the general knowledge on antibiotics and AMR, the HCP attitude towards antibiotic prescription and AMR and the practice in applying the appropriate antibiotic prescription. Most of HCPs (93.7%) recorded good knowledge level about antibiotic prescription and antimicrobial resistance with mean score of knowledge13.21 ± 1.83. About 79% of HCPs recorded a positive attitude towards proper antibiotic prescription with mean score of attitudes 63.02 ± 7.68. Fifty four percent of HCPs demonstrated a good level of practice with mean score of practice 9.75 ± 2.17. In conclusion, HCPs in our study have a good level of knowledge and attitude about antibiotics. However lower level of proper practice towards the problem of AMR in COVID19 era was noticed. Implementation of effective policies and guidelines is crucial to evaluate the antimicrobial use especially in the COVID-19 era to reduce the unintended consequences of the misuse of antibiotics and its impact on AMR.

Functional Materials to Overcome Bacterial Barriers and Models to Advance Their Development

AbstractWith the emerging problem of antimicrobial resistance, the world is facing a slow but dangerous pandemic. While the discovery of novel antibiotics is reaching a nearly exhaustive end, new concepts for anti‐infective drugs are emerging. So‐called pathoblockers aim to de‐weaponize bacteria rather than just killing them. As the target of these molecules is typically located intracellularly, however, hitherto almost unnoticed biological barriers are emerging such as the biofilm matrix, the bacterial cell envelope, efflux pumps, and eventual bacterial metabolism. This leads to a new paradigm that is to maximize bacterial bioavailability. To overcome the bacterial barriers, especially when further optimization of the active molecules is not possible, functional materials are needed to engineer innovative delivery systems. Those may not only enable novel anti‐infective molecules to reach their targets, but will also improve the bacterial bioavailability of existing anti‐infectives. Additionally, there is a need for better infection models that allow studying drug effects on both the bacteria and the host in a relevant manner as needed for rational anti‐infective drug development.

Two pandemics: the COVID-19 pandemic’s impact on future AMR collaboration in Europe

Based on 117 responses to a web survey in 29 European countries and interviews with bureaucrats in managerial positions, this paper investigates how people working professionally with antimicrobial resistance (AMR) assess the impact of the COVID-19 pandemic on their future long-run cooperation in the struggle against AMR, both within their own country and among the European countries. We measure whether the severity level of the AMR problem, cumulative COVID-19 death rates, and the daily number of confirmed new COVID-19 cases in their own countries have affected bureaucrats’ beliefs about long-run AMR collaboration. We find that around 40% of the bureaucrats believe that the cooperation will increase domestically and at the European level, indicating that global health crises such as the COVID-19 pandemic can shape future collaboration across the European countries when it comes to the equally global but more long-run health problem, AMR. However, there are considerable differences across regions: Eastern European bureaucrats are clearly the most pessimistic about future cooperation, while the Southern European and Nordic bureaucrats are the most optimistic. Neither the severity of the AMR problem nor the number of confirmed new COVID-19 cases in their own countries has a significant impact on bureaucrats’ beliefs about future collaboration. Instead, it is the cumulative COVID-19 death rate that increases the perceived likelihood of future AMR collaboration, both domestically and among the European countries. Furthermore, our interviews highlight the longer-term impact of the pandemic on public health in the EU countries and the prospect of increased EU control to prevent future cross-border health hazards. The mixed methods approach details both the broader patterns of bureaucrats’ perceptions of the impact of the pandemic on AMR-related work as well as the more long-term institutional changes that are likely to follow in the wake of the pandemic.